Abstract
Introduction: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in the general population. How much it is a harbinger of cardiovascular disease (CVD) is controversial. We therefore analyzed the association of NAFLD with CVD in NHANES.
Method: Data on 11,427 non-pregnant adult participants of NHANES 1999-2014 without viral hepatitis, diabetes on drug treatment and missing data in key variables were analyzed using the SPSS complex samples module. As ultrasound examination of the liver was not performed in NHANES, we used three non-invasive scores, fatty liver index (FLI), NAFLD liver fat score (LFS) and hepatic steatosis index (HSI) as markers of NAFLD. Logistic regression was used to examine their association, per standard deviation change, with CVD outcomes, namely, coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and stroke.
Results: 13.6% of participants had elevated LFS. The number of participants with self-reported CHD, MI, HF and stroke were 417 (3.1%), 430 (3.1%), 274 (1.8%) and 358 (2.4%), respectively. The main results are shown in the table. LFS was associated with increased risk of CHD, MI and HF with AUC of 0.595, 0.592, and 0.590, respectively (p<0.0001 for these outcomes). FLI was associated with increased risk of MI and HF with AUC of 0.594 (p=0.013) and 0.616 (p<0.0001), respectively. HSI was associated with increased risk of HF (AUC: 0.514). None of these scores was associated with stroke.
Conclusion: With a large study population, we could discern a small but significant association of CHD, MI and HF with NAFLD. Although NAFLD is common in the general population, it is associated with only a slightly higher prevalence of CVD.
